How to Make the Lifestyle Changes Your Doctor Suggests

Doctors prescribe lifestyle changes for all sorts of health issues: a low-everything diet and thrice-weekly cardio to bring down cholesterol; lots of sardines and circuit training to temper multiple sclerosis symptoms; consistent sleep and 45 minutes of daily movement to help stave off depressive lows. Of course, actually making medically recommended changes is often easier said than done, and research suggests that, across the board, people only hit about half of their intended health goals. But while forming a new health habit takes discipline and focus, success isn’t only about willpower. The right perspective goes a long way when it comes to self-regulation, meaning the ability to commit to a new behavior.

It’s normal to hit rough patches in pursuit of health goals or have trouble finding the motivation to upend your day-to-day rhythms. Fortunately, health psychology research offers some practical strategies to help you follow through on your doctor’s orders.

Get involved in your care

Getting a diagnosis or any less-than-ideal medical news can disrupt your sense of control over your own well-being. When you feel like your health is spiraling, it can help to focus on things you do have a say in, such as your treatment plan. Research shows thatpatientautonomy, the ability to choose health pursuits that align with your personal values, can increase engagement with healthy behaviors and resilience against temptations.If you feel a sense of ownership over the goal you’re trying to hit, you’ll be more motivated to get there. Researchers say self-knowledge, or an awareness of your goals and personal values, is the first step in asserting autonomy.

Let’s say that your doctor recommends a diet overhaul on account of your rising cholesterol and family history of heart disease. Then the doctor hands you a list of eating rules and bland, heart-healthy recipes that don’t appeal to you. You shouldn’t just say thanks and take off. Instead, talk to the doctor about the nutritional principles behind the diet and come up with a way to make it work for you. Is scouting out a farmer’s market for seasonal veggies your idea of a fun Saturday morning? Would a meal-planning service work best with your schedule?

But autonomy is a two-way street. Self-knowledge won’t do you much good unless your doctor is open to your involvement. Seek out a provider who not only listens to your questions and concerns but also wants to hear your perspective. To ensure a sense of autonomy with your practitioner, don’t be afraid to ask questions.

“For choice to be truly autonomous, patients must adequately understand the choice options and their potential consequences,” says Danielle Cosme, a psychology doctoral student at the University of Oregon. “Patients can increase their autonomy by stating explicitly to medical practitioners when they don’t fully understand care options, and by requesting additional information necessary to make decisions in line with their treatment goals.”

Explainers

Be kind to yourself

Even the most regimented health fanatics face setbacks. If you view a missed workout or a diet slip-up as a failure, you’ll be more likely to drop the routine altogether. Rather than beat yourself up for a perceived defeat, cut yourself some slack and move on. Adopting a gentler approach toward self-discipline, one study found, can save you from becoming overwhelmed and make it easier to regulate your emotions and behavior — which gives you more time and energy for healthy choices later on. Unsurprisingly, the study found a compassionate approach toward goal adherence to be especially beneficial for those with perfectionist tendencies.

“Instead of ruminating on perceived failures, isolating oneself and beating oneself up, individuals will identify the setback with compassion and move forward with the exercise or nutrition plan,” says study coauthor Duke Biber, an assistant professor of sport management, wellness and physical education at the University of West Georgia.

In practice, what does it mean to show yourself compassion? Treat yourself how you’d treat a friend in your situation. Chances are you wouldn’t punish your loved ones for getting derailed. You’d simply remind them of their progress and encourage them to keep at it.

To incorporate self-compassion into a health routine, start by monitoring your self-talk. Biber says awareness of how you speak to yourself during challenging moments can help you sub out negative thoughts for more positive, motivating messages. He also recommends writing a compassionate letter to yourself that lists the goals you want to achieve in the future. “This practice,” he says, “will help you create a ‘healthy identity,’ as well as learn to overcome setbacks with compassion.”

Make it fun

Let’s face it: Taking on a healthy habit (or swearing off an unhealthy one) typically isn’t a rollicking good time. But allowing the process to be a bit more enjoyable can boost your odds of making a good-for-you habit stick.

In a 2014 study, Katherine Milkman, a behavioral scientist at the University of Pennsylvania, ran an experiment to test the impact of instant gratification on exercise motivation. When study participants were allowed to listen to a page-turning audiobook (think The Hunger Games or The Da Vinci Code) during gym sessions, they were far more likely to hit the gym frequently.

Milkman calls this concept “temptation bundling,” and she says it can promote adherence to healthy habits. The key is to only let yourself give in to the temptation while you’re practicing the new habit, she says: “That way, you’ll do it more often.”

While her study focused on gym attendance, Milkman says pairing other healthy behaviors with small treats could be just as effective. “You could schedule a weekly date with a friend to get salads for lunch, and don’t let yourself hang out with that friend for a meal unless you’re eating there,” she says. “If you want to eat more healthy, home-cooked meals and less gluttonous takeout, you could only let yourself enjoy your favorite podcast while cooking fresh and healthy foods.”

Lose control once in a while

Discipline is obviously beneficial for habit formation, but overly black-and-white thinking might not be. That’s why all-or-nothing crash diets tend to fail. To develop habits that stay with you for the long haul, go ahead and let yourself cheat every now and then.

A psychological theory called ego depletion says that self-control is a limited resource. Your ability to self-regulate behavior weakens with overuse, just like a muscle. If you resist the same urge repeatedly, your craving will grow as your willpower muscle tires out. And you’ll end up giving in later on, in a much bigger way than you would have 10 self-denials ago. While ego depletion has received some pushback in recent years, it’s the foundation of a lot of research on willpower.

For instance, if you’re trying to rein in your erratic sleep schedule, that doesn’t mean you need to decline every invitation for a night out. Instead, allow yourself to break your self-imposed curfew once a week. By giving yourself room to indulge, you’re saving your self-control for when the urge is strongest and hardest to resist — and setting yourself up for a longer-term commitment to healthy sleep.

Focus on the right rewards

When you’re working hard to achieve a health goal, it’s easy to think about superficial benefits, like how great you’ll look after a few months of daily runs. But focusing on inward improvement will get you further.

When it comes to promoting healthy behaviors, there are two kinds of rewards: hedonia (H-rewards) and eudaimonia (E-rewards). H-rewards are more concrete and surface-level, like losing weight to improve your appearance. E-rewards provide a sense of meaning by contributing to your overall sense of well-being. Dr. Srini Pillay, a psychiatrist and professor at Harvard Medical School, says these deeper, longer-lasting rewards make for more motivating, sustainable goals.

For example, if your physician suggests upping your cardio, focus on the long-term benefits of improved cardiovascular health rather than dropping a pants size. This can be hard to do, but internal goals are the strongest agents of positive change.

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For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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